European Stars and Stripes (Newspaper) - October 8, 1991, Darmstadt, Hesse                                Imagined ugliness the latest in debilitating disorders 9 by Daniel Goleman the new York times a woman in her 30s, convinced she had excessive facial hair was so intent on not being seen in Public that she sped from place to place on a motorcycle. She would even run red lights for fear someone would see her As she waited for the Light to change. A Man in his 20s Felt people stared at what he imagined were his Quot pointed ears Quot and Quot Large  he eventually quit his Job and stayed Home rather than face the humiliation he was sure awaited him outside. And a 28-year-old Man who was preoccupied with his thinning hair was Unco Soled by reassurances from four dermatologists that his hair loss was Normal and barely noticeable. He became deeply depressed. Each of these people was suffering from what psychiatrists Call body Dys orphic disorder or imagined ugliness a relatively new formal diagnosis. Such cases Are being reported with greater and greater frequency. Though the diagnosis is made comparatively rarely psychologists studying body image estimate that 2 percent to 10 percent of people Are so self conscious about some aspect of their looks that it constricts their life in some Way keeping them from making love or dating and even rendering them Home bound or suicidal. Many make a fruitless round of cosmetic surgeons never satisfied. To be sure the Large majority of people have some dissatisfaction with their bodies 85 percent of women and 72 percent of men Are unhappy with at least one aspect of their appearance according to research by or. Thomas Cash a psychologist at old Dominion University in Norfolk a. But for most people such dissatisfaction does not become a consuming preoccupation calling for therapy. Such obsessed people see Gargantua s belly or Cyrano s nose in features that go unremarked by others. Most keep secret their firm belief that they Are deformed. They May spend hours staring in mirrors at the imagined deformities and May go to great lengths to disguise them with clothing or cosmetics. But typically Quot they Don t Tell a soul Quot said or. Katherine Phillips a psychiatrist at Harvard medical school. Her article on imagined ugliness was in the september Issue of the american journal of psychiatry. Frequently such people go into therapy for other problems particularly depression but often Are so ashamed of their imagined disfigurement that they do. Not confide their preoccupations even to the therapists said or. Phillips. And because they Are More Likely to consult cosmetic surgeons or dermatologists than psychotherapists they typically get no psychological treatment. A virtually All patients who come for elective cosmetic surgery see some body part As ugly Quot some for Good reason but Many Tor thatures that other people would not be dissatisfied with said or. Thomas Pruzinsky a psychologist in Hamden con who screens patients seeking cosmetic surgery. He added Quot people who Are dissatisfied with some feature that most others Don t notice would do better to change their attitudes than their  cosmetic surgeons have Learned to be wary of people who imagine themselves far More ugly than they seem to others. Quot these Are the patients who Are never satisfied with How their cosmetic surgery turned out Quot said Cash who is co editor with Pruzinsky of body images published last year by Guilford press the number of people who say they Are unhappy with their physical features though not Neces Sanly to the extent that therapy is needed has risen markedly Over the last two decades for example a 1972 Survey by Cash said Attiat 35 percent of men and 98 percent of women were dissatisfied with then weight try i985 the Tigues had risen to 4 i percent Lor men and 55 percent Tor women the same surveys indicated that in 1972, 8 percent of men and 11 percent of women were dissatisfied with a facial feature by 1985 dissatisfaction was at 20 percent for men and women. Body image researchers Are troubled by findings like a 1987 Survey of 500 children in elementary school that found More than half the girls thought they were overweight and 31 percent of 10-year-Olds said they Quot Felt fat Quot though Only 15 percent were actually heavier than the Norm. Researchers say that such distorted thinking plays a Large role in the development of eating disorders. Distorted views of the body Are due in part to Quot an insidious contrast effect a in which people compare themselves with the models in advertisements said or. Rita Freedman a psychologist in Scarsdale . Quot carefully contrived advertisements compress standards of attractiveness into a Young idealized extreme that is virtually unattainable Quot said Freedman who has developed treatments for the problem. Because the psychological pressures of these standards fall More heavily on women than men women Are on average More negative about their bodies than Are men. A for example in a 1989 study of 80 men and women volunteers carried a Beeper that randomly signalled them to record their circumstances and thoughts about their body. Men reported Many More positive thoughts than did women. Women More frequently reported judging some part of their body harshly. Quot ears and lips Are the Only part of their body that women Are More positive about than Are men Quot said or. Stephen Franzoi a psychologist at Marquette University did the study. Quot ears and lips of course Are easily changed or adorned in  in a study of the feelings of 108 men and 122 women about specific body parts Franzoi found that men and women Are most dissatisfied with parts like the stomach thighs and hips which reflect overweight. He. Reported his findings at the annual meeting of the american psychological association in August. It was Only in 1987 that imagined ugliness was recognized As a disorder in the official psychiatric diagnostic manual. Surveying literature on the topic Phillips found hundreds of european articles but just a handful by american researchers. Still records of cases of imagined ugliness Are As old As psychotherapy itself. Freud wrote that one of his patients known As the Wolf Man Quot neglected his daily life and work because he was engrossed to the exclusion of All else in the state of his nose Quot making painstaking observations in a pocket Mirror around which Quot his life was  because plastic surgeons Are the first professionals to see so Many of these patients some treatment approaches Are designed for people who seek cosmetic surgery. Pruzinsky for instance has worked with or. Milton Edgerton a plastic surgeon at the University of Virginia who has had a psychologist or psychiatrist on his staff for 30 years. In the october Issue of plastic and reconstructive surgery they will report on 100 patients who were identified As disturbed. Quot most plastic surgeons turn such patients away Quot said Pruzinsky. Quot we designed a treatment that combines psychotherapy and  the treatment focused on helping the patients gain a More realistic sense of what they could and could not expect from cosmetic surgery. Quot i find that you re not going to cure them of their dissatisfaction with their body through  said Pruzinsky. Quot the main problem is that they Are not motivated to change their View Quot other psychotherapists disagree Freedman said Quot their is such a thing As real ugliness but it s not Neces Sanly a psychological problem there is a place Foi cosmetic surgery but it s oversold the internal feelings am Moie in Poisant than the features Thomso Hes Diann Kearney Cooke a psychologist m  said whenever you talk about your body you re talking about the Way you see yourself. If you feel bad about yourself you project it onto your  Kearney Cooke s approach is to help people see the connection Between emotional states and feelings Beu their bodies. Quot one woman told me she was in a be.-. J meeting when she suddenly got self conscious the. Had acne scars and her nose was too big she a a a a 3 i asked her to recall exactly what was happen Quot that moment she had just been challenged to de a her  on. I he h deep inside made tier feel Page 14 b the stars and stripes  breast implants for men a amps Wes Booher adequate and  in therapy with the woman Kearney Cooke had her tax then Call to mind occasions in her Early life when to e had Felt similar feelings. It s often a moment like when parents ignore a child in o has come Home from school Quot said Kearney Cooke o child turns that feeling of being rejected onto 3  about her own body. But once they see that i Quot of feeling that s the problem they can begin to so that their feelings about their body Are a by Elisabeth Rosenthal a the new York times to camouflage her Skinny calves the 30-year-old film producer from Southern California always wore Long skirts and Quot Felt like a Freak Quot when she played Tennis or ran. For years she lifted weights to improve the contour of her legs to no Avail. Quot doctors told me its just the Way your muscle is formed Quot she said in a recent Telephone interview. Quot but i was always self conscious. I thought someday they re going to develop some Way to help  a year ago someday arrived. At a Beverly Hills clinic a plastic surgeon made a tiny incision behind each of her Knees and slipped silicone implants into her calves. Quot my Mother said a of god do you have to do it a Quot the woman said. Quot but its great. I be been really  Welcome to the frontiers of cosmetic surgery. To achieve the Ideal form a growing number of patients Are undergoing implants to enlarge their calves chests and even buttocks they have liposuction to Siphon fat from their Cheeks or necks and they get lips plumped up with tissue borrowed from their own scars. Although face lifts were once the province of older women cosmetic surgeons say there has been a huge increase in patients from 35 to 45. A ten years ago surgeons used to think it was frivolous to operate on people under 50,&Quot said or. Ronald Iverson chairman of the Public information committee of the american society of plastic and reconstructive surgeons. Quot part of the change has been induced by better results but mainly its what people  men too Are demanding equal time seeking younger faces bigger chests and Quot correction Quot of Cleft chins. One plastic surgeon tells of a Man who envious of a spouses breast augmentation demanded a new set of pectorals to keep Pace. Next months edition of clinics of plastic surgery is devoted to cosmetic surgery for men and or. Brian Novack a plastic surgeon in Beverly Hills who estimates that 65 percent of his patients Are male predicts that half of All patients will someday be men the current figure is slightly Over 10 percent. Quot it s a big change to see Good looking Guys in their 40s asking for face lifts Quot said or. Fritz e. Barton a professor of plastic surgery at the University of Texas Southwest medical Center in Dallas. Although the trend is consistent All across the country the epicentre is of course Southern California. Quot it s a combination of people who Are very body conscious and a group of very interesting and innovative surgeons and they feed off each other Quot said or. Norman Cole the president of the american society of plastic and reconstructive surgeons. Quot some of them Are blowing new  while some of the techniques like facial liposuction Are now widely offered by plastic surgeons others like pectoral implants Are regarded by Many with a snicker and surgeons worry that patients seeking what Are permanent changes May be Overly influenced by current fashion. Patients sometimes travel to California for the expertise. They say the pain of surgery and its Cost a up to $5,000 for a pair of calves rarely covered by insurance a Are Well worthwhile. But those who Are less body conscious May have a hard time believing that Skinny legs can ruin a life or that women still having children should be contemplating face lifts. The motivations of patients who seek out these most cosmetic of cosmetic operations Are diverse surgeons say that the typical implant patient is Young and extremely athletic but has been unable to achieve an Ideal body contour through weight lifting in fact pectoral implants tend to produce better results if the patient continues to exercise since the implant sits deep under the san and the patient s own muscle  True she a Tuie for men and women seeking face lifts at 40, the motivation is often to look and feel a bit younger in a society that has put an increasing Premium on youth and so cosmetic surgery has flourished in the midst of a major recession. Quot in a tight Job Market people see a face lilt As an investment in their competitiveness Tor jobs Quot said Barton. Even among plastic surgeons the growing popularity of implants has been a source of some concern. Many of the implant procedures first achieved popularity in the body building gyms of Southern California in the Middle of the last decade but have moved into the general population in the last two years said or. Adrien Aiache a los Angeles surgeon who has pioneered calf implants. In these operations carefully sculpted solid silicone pieces Are inserted under skin and sometimes muscle to enhance normally curvaceous portions of the body implants made of the same material have been used successfully for decades to restructure chins and Are thought to be far safer than liquid silicone breast implants which have recently come under scrutiny by the food and drug administration because they can cause deforming scars and serious allergic reactions. More than 100 buttock and pectoral implants were performed by members of the american society of plastic and reconstructive surgeons in 1990, the first year the society kept tallies and close to 300 Call implants were performed. The incisions Are generally inconspicuous hidden in the armpit for pectoral implants and in the cease behind the knee for calf surgery. Although some patients experience severe pain for weeks particularly those with calf implants once the tissue heals they say they Are not aware that the implant is in place. A like a typical male i wanted the biggest size Quot said a 49-year-old insurance executive from Pennsylvania who had calf implants two months ago. Quot the ones he put in were two sizes smaller they look natural and Are a much better balance with tie top of my  with pectoral implants Quot if a person has Small shoulders and arms and you build them up too much they just look silly Quot said Novack who said that patients bring in surfing magazines and Calvin Klein ads. Quot and the implant has to fit under their Normal Chest  Iverson said that there was Quot no reason to think that these implants were not Safe and effective Quot but noted Attiat they had not been used for very Long and that surgeons could not predict for certain How they would Wear for 50 years under the skin of a 20-year-old. Some plastic surgeons Are particularly worried about the Cau and buttock implants since a unlike chins a these areas of the body Are constantly in motion with Large powerful Muscles sliding by. The doctors worry that movement and Gravity could cause the implants to travel under the skin Over time. And then people sit on buttocks All Day Long and no one knows How the implants which provide no additional cushioning will Wear Over time. Other surgeons say that the lower leg is frequently plagued by poor circulation As the body Ages which they fear May make calf implants an Ideal Breeding ground for serious infections. The push to do cosmetic surgery on younger faces has met with far wider acceptance by the age of 35, plastic surgeons say Many a face has started to Sag and could Benefit from some restructuring face lifts on the Young generally  in Dixie rent areas and involve somewhat different Ltd it Haig i s from those performed on older people Toa  signs of age first around tin. Of non a t a a my 1 Sluter around the Mouth and no l in the  face lift l it a �1 1 a 1 a 1 1 1 a a ii 1111 a11, r. It. I. I a d r 4 in a a Quot t 8, 1991 thl stars and strut s b age 15